Nursing home managers' descriptions of multi-level barriers to leading person-centred care: A content analysis.

BACKGROUND: Research suggests that person-centred care can be beneficially implemented and sustained, even though barriers remain that prevent uptake in clinical practice. Understanding barriers to person-centred care seems important, as this has an impact on care practices and resident outcomes. Moreover, there is limited knowledge about nursing home managers' descriptions of barriers when leading person-centred care. OBJECTIVES: To explore barriers to leading person-centred care as narrated by nursing home managers. METHODS: A descriptive qualitative design was used to collect data using individual interviews with 12 nursing home managers in highly person-centred nursing homes. Data were analysed using content analysis. RESULTS: Multi-level barriers to leading person-centred care were identified on the (1) person level, (2) team level and (3) organisational level. Placing professional and family considerations ahead of resident considerations was described as a barrier on the personal level (1). Also, staff's divergent care values, processes, and priorities together with turnover and low foundational knowledge were identified as barriers on the team level (2). On an organisational level (3), constrained finances, functional building design and group level rostering were identified as barriers. CONCLUSION: Multi-level barriers influence nursing home managers' ability to lead and promote person-centred care. Promoting the development of person-centred practices requires efforts to eliminate barriers on person, team and organisational level. IMPLICATIONS FOR PRACTICE: Identifying and overcoming barriers at various levels in nursing home care has the potential to promote person-centred practices. This study can inform stakeholders and policymakers of challenges and complexities in person-centred practices. Multi-level strategies are needed to target challenges at person-, team- and organisational level when striving to develop person-centred care.

Embodying person-centred being and doing: Leading towards person-centred care in nursing homes as narrated by managers.

AIMS AND OBJECTIVES: To explore how managers describe leading towards person-centred care in Swedish nursing homes. BACKGROUND: Although a growing body of research knowledge exists highlighting the importance of leadership to promote person-centred care, studies focused on nursing home managers' own descriptions of leading their staff towards providing person-centred care is lacking. DESIGN: Descriptive interview study. COREQ guidelines have been applied. METHODS: The study consisted of semi-structured interviews with 12 nursing home managers within 11 highly person-centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis. RESULTS: Leading towards person-centred care involved a main category; embodying person-centred being and doing, with four related categories: operationalising person-centred objectives; promoting a person-centred atmosphere; maximising person-centred team potential; and optimising person-centred support structures. CONCLUSIONS: The findings revealed that leading towards person-centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co-ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person-centred philosophy into synchronised care actions. RELEVANCE TO CLINICAL PRACTICE: The findings can be used to inspire nursing home leaders' practices and may serve as a framework for implementing person-centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person-centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person-centred care.

Prevalence and Correlates of Sexual, Physical, and Psychological Violence Against Women and Men of 60 to 74 Years in Sweden.

Past-year sexual, physical, and psychological violence against women and men aged 60 to 74 years was studied. The data derived from a nationally representative survey on violence in which approximately 2,800 women and men aged 60 to 74 years in Sweden participated. Women were significantly more likely to have been subjected to at least one form of violence in the past year. The prevalence of sexual violence as well as systematic and repeated psychological violence was found to be significantly higher for women than for men. Sexual violence was the most common form of violence against women. Systematic and repeated psychological violence was the most common form of violence against men. Additional gender differences were found in relation to victim characteristics. While associations among women were found between violence victimization and sociodemographic characteristics, health as well as social capital, only health-related characteristics were found to be associated with past-year violence victimization among men. Among women, economic problems, posttraumatic stress disorder (PTSD) symptoms, lack of trust in other people, and not having anyone to talk to were associated with violence victimization. Poor psychological health and an at-risk consumption of alcohol were found to be associated with violence victimization among men. The results highlight the importance of research on violence victimization to assess gender differences also when inquiring into the situation among persons in older generations. The results also indicate practical implications for caring professions; the need to inquire into the experiences of violence among older persons and to pay particular attention to these characteristics when encountering women and men in this age interval.